Miroslav Mako, Georgi Krastev
Parkinson disease (PD) is defined as ireversibile degeneration of dopaminergic cells in pars comapacta of substantia nigra, which leads to continous decrease and following loss of dopamine of striatum. Despite of long-term research, levodopa is still the most effective symptomatic treatment of Parkinson disease. Non-fyziologic pulsatile dopaminergic treatment can start dysregulation of several neurotransmiter systems in basal ganglia and ireversible damage in postsynaptic dopaminergic neurons in striatum leading to late motor complications and fluctuations. There is a summary of current medical treatment options for patients with advanced Parkinson disease in this paper. A case report of patient with advanced Parkinson disease treated with continuous subcutaneous infusions with apomorphine is referred.